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Artificial Disks

I am new to your forum, and cannot believe it has taken me this long to look here for help!

I hope someone out there has experience with the following - either good or bad.

I had a fusion with rods from T10 to L5 five years ago. My recovery was remarkable, I was lucky to have a great surgeon, and lots of support. I went on my way without realizing I could do damage to anything in my back. Now 5 years later the disk at L5 S1 is gone. I am bent forwards at my hips, and listing sideways I suppose because of the angle the vertebrae are resting on each other. I am in varying states of mobility and pain each day, with no control of any of it. My original surgeon has since retired.

My at-home option is to have another surgery - this one would be to remove the old rods and install new ones, slightly longer to get to S1, also install long pins inside my hips to build a tripod-like device inside me.

My away-from-home option is to go to the Stenum hospital in Germany, where they will install an artificial disk where mine is now missing. Their procedure is anterior access, just to that interface. The disk they will use is their new one called the M6.

Does anyone have experience with either of these procedures?

I appreciate any response, I am definitely struggling with what to do.

I am new to your forum, and cannot believe it has taken me this long to look here for help!

I hope someone out there has experience with the following - either good or bad.

I had a fusion with rods from T10 to L5 five years ago. My recovery was remarkable, I was lucky to have a great surgeon, and lots of support. I went on my way without realizing I could do damage to anything in my back. Now 5 years later the disk at L5 S1 is gone. I am bent forwards at my hips, and listing sideways I suppose because of the angle the vertebrae are resting on each other. I am in varying states of mobility and pain each day, with no control of any of it. My original surgeon has since retired.

My at-home option is to have another surgery - this one would be to remove the old rods and install new ones, slightly longer to get to S1, also install long pins inside my hips to build a tripod-like device inside me.

My away-from-home option is to go to the Stenum hospital in Germany, where they will install an artificial disk where mine is now missing. Their procedure is anterior access, just to that interface. The disk they will use is their new one called the M6.

Does anyone have experience with either of these procedures?

I appreciate any response, I am definitely struggling with what to do.

Hi...

The few cases I've heard of, of people having artificial discs implanted below a long fusion, have bad outcomes. There was a woman on one of the Flatback lists, who really had a terrible outcome.

This was something in which I was really interested, as I have 2 bad discs below my fusion, and really don't want to end up having to be fused to the sacrum. I volunteer at UCSF with some very highly skilled scoliosis surgeons. One of them (who regularly implants artificial discs in appropriate patients) told me that he wouldn't even consider it.

I am on another back pain related board because of a herniated disc at L5/S1. The other board is more for people with herniations, stenosis, etc. (not a lot of scoliosis). The general consensus on that board, is that L5/S1 is not a good place for an artificial disc, due to the natural lack of mobility at that level. In general, fusion is recommended for disc problems at that level. I realize your previous fusion will complicate this, but I would be very wary of the artificial disc at that level. Good luck in whatever you decide.

- 39 years old
- At age 14, curve progressed from 45 degrees to 62 degrees in two months.
- Surgery in 1990 at the Children's Hospital of Eastern Ontario (CHEO) with Dr. Letts. Fused T5 to L2. Corrected to about 30 degrees.
- Harrington rod
- Herniated disc - L5/S1 - January 2008. Summer 2009 - close to making a full recovery.
- New mommy as of February 2011
- Second child - September 2013
- Staying relatively painfree through physio exercises!

x-stop surgery

I remember hearing about x-stop surgery being done at the University of Rochester and elsewhere for people with stenosis. That's what I have, but this surgery is not recommended for people with scoliosis, I believe due to the different forces at work. This is not a disk replacement, more of a spacer, but I believe same line of thinking.

I was fused to L5 and my fusion grew on its own to S1. I had to have part of the fusion removed because it was pressing on my spine. 4 years later I went to a scoliosis doctor because of many other problems with my back. He told me that some of the pain at the base of my spine was due to the L5 - S1 disc being just about gone. He said he could fuse me with bone and a couple of plates, but that with it already partially fused (the surgeon did not remove all the fusion), that he wouldn't reccomend it. He said the fusion that was removed was growing back again.

I had first scoliosis surgery in 1977 with harrington rods and fusion from T1-L2. I started getting numbness and tingling in left leg in 2001 and was diagnosed with 3 degenerated disks between L3 and S1. After living eight years with discomfort and worsening symptons, I had 3 disks replaced, additional support hardware installed and attached to my existing rods, and fusion from L3-S1 using own bone material in February 2009. Recovery has gone well and I can do all tasks of living and having fun again. Maybe disk replacement alone is not recommended but with fusion and support hardware, you can probably get relief. Ultimately, your pain and discomfort level will likely guide you where to proceed next.

I think you may be confusing technologies. If you have rods attached to the vertebrae above and/or below the discs that were replaced, you almost certainly don't have artificial discs. Artificial discs are devices that allow movement of the joint (which rods would defeat). Here's a picture of an artifical disc.

A Decision

Thank you all for responding - I find decisions are easier the more information I have at my disposal.

The artificial disk technology has apparently been highly successful for folks with out previous hardware, but there are no success stories for me to use as references in my case.

I have decided to go ahead with traditional surgery - my date is near the end of Feb. I am finding my condition and ability to cope with it is rapidly degenerating, so the date can't come fast enough.

My entire hardware, which includes titanium rods and hooks and screws, will be removed and replaced with a longer assembly made of stainless steel. I will end up with a permanent connection from S1 to my sacrum. My surgeon assures me he has patients who have all this hardware and can still place their palms on the floor with their legs straight. I want to be one of those - I haven't been able to do that since I was 12, lol.

Thank you again. I am so pleased to have found this site, it is so helpful to share and hear of others who have similar conditions

Following scoliosis surgery, lumbar motion segment degeneration below the level of fusion is not uncommon. Especially long fusions extending to the mid and lower lumbar spine increase the likelihood of degeneration of the remaining motion segments. The management for these patients is controversial and depends on the clinical presentation and level of degeneration. The increasing confidence in motion-preserving technology leads to a dilemma on whether to fuse the remaining lumbar levels or risk utilising disc arthroplasty to preserve the remaining motion segments and facilitate coronal balance in patients with previous long fusion for scoliosis. We present an interesting case of a 44-year-old lady, who underwent two-stage corrective surgery for progressive idiopathic scoliosis at the age of 22 years. In the first stage, she had T11-L3 anterior fusion, whilst in the second stage posterior fusion was done from T5 to L3. At 22 years after the initial surgery, she presented with worsening low back pain and bilateral L4 radicular symptoms. MRI scan confirmed severe disc degeneration at L3-4 and L5-S1 levels with preserved L4-5 disc. She initially underwent L3-L4 decompression and posterolateral fusion at that level, which relieved her radicular symptoms. However, she had persistent pain at the lumbosacral junction with Modic I changes. The options of an anterior L5-S1 fusion or disc replacement were considered and discussed with the patient. The disc replacement option was decided upon with the patient, as anterior fusion was judged to increase the risk of coronal imbalance. At the 1-year follow-up, she reported significant improvement in the back pain. The radiographs at 1 year showed satisfactory position and function of the artificial disc replacement. The disc was flexed laterally, accommodating the coronal balance of the spine. We conclude that L5-S1 motion segment can be preserved with artificial disc replacement in patients with previous long fusion for scoliosis surgery. The real difficulty arises when choosing between disc replacement and extension of fusion. In our patient, the disc replacement has worked well so far. However, the disc is clearly at a mechanical disadvantage, and loss of function in the mid- or long term would not be surprising.

PMID: 20803157 [PubMed - as supplied by publisher]

Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
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Surgery 2/10/93 A/P fusion T4-L3
Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation